MEASLES PREVENTION & CONTROL IN MALAYSIA Handbook for Healthcare Personnel

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2 Contents PAGE Foreword 3 PART 1 - GENERAL Introduction The Disease Complication People At Risk Measles Vaccination Measles Epidemiology Global 7 PART 2 - MEASLES PREVENTION AND CONTROL IN MALAYSIA Measles Epidemiology - Malaysia Measles Elimination Goal & Objectives Strategies Measles Vaccination Schedule Contraindication Measles Surveillance Objectives Case Definition Case Classification Procedures Of Surveillance Performance Indicators 14 APPENDICES Appendix 1 : Flow Chart Of Measles Surveillance Activities 16 Appendix 2 : Measles Laboratory Request Form 17 Appendix 3 : Procedures To Collect, Store And Transport Clinical Specimens 19 Appendix 3a : Blood Specimen Collection For Measles Specific IgM Test 20 Appendix 3b : Urine Specimen Collection For Measles Virus Isolation 21 Appendix 3c : Nasopharyngeal Specimen Collection For Measles Virus Isolation 22 Appendix 3d : Throat / Nasal Swab Specimen Collection For Measles Virus 23 Isolation Appendix 4 : Flow Chart Of Clinical Specimen For Laboratory Confirmation 24 And Result Appendix 5 : Notification Form (Malay Version) 25 Appendix 6 : Notification Flow 26 Appendix 7 : Measles Investigation Form (Malay Version) 27 Appendix 8 : Classification Of Measles Case 30 Telephone Numbers 31 References 32 Acknowledgement 33

3 FOREWORD Measles is one of the major childhood killer before the introduction of its vaccine. and World Health Organization (WHO) estimated that 130 million children below 6 years die due to measles annually. Since the introduction of measles vaccine in 1964, the morbidity and mortality due to measles have been reduced drastically. Measles vaccination was included in the Expanded Program for Immunization (EPI) in Since then, coverage of measles vaccination climbed steadily in all regions throughout the year 1980s. In 1980s, after the success of smallpox eradication, some scientist and public health officials have considered of global effort to eradicate measles. Since 1990 s strategies have been planned and implemented in many developing countries to eliminate and eradicate measles. Three regions of the World Health Organization that targeted elimination by 2000s are; in 1994, the American Region targeted elimination by 2000, in 1997, the Eastern Mediterranean targeted elimination by 2010 and in 1998, the European Region targeted elimination by In 2005, WHO for the Western Pacific Region targeted elimination by As we have succeeded in controlling measles occurrence at low level, the Ministry of Health in February 2003 decided to initiate measles elimination in Malaysia starting in Therefore, all healthcare personnel should implement the measles prevention and control strategies and activities as required for the elimination. This handbook is intended to serve as guiding tool in continuing to create awareness and assisting healthcare personnel in the implementation of Measles Elimination Programme strategies. Dato Dr. Hj. Ramlee Hj. Rahmat Director of Disease Control Ministry of Health, Malaysia 18 December 2006

4 PART 1 GENERAL 1.1 INTRODUCTION Before the introduction of measles vaccine, measles is one of the major childhood killer and the World Health Organization (WHO) estimated that 130 millions children below 6 years die due to measles annually. Since the introduction of measles vaccine in 1964, the morbidity and mortality due to measles have been reduced drastically. However, despite the availability of vaccine for the past 40 years, measles is remains a leading cause of death among young children. An estimated 454,000 people died from measles worldwide in Measles vaccination and surveillance are two main strategies to prevent and control the diseases. 1.2 THE DISEASE Measles is highly infectious disease caused by a virus in the paramyxovirus family. The disease spread by airborne droplets, close personal contact or direct contact with nasal or throat secretion of infected persons. The incubation period is usually 10 to 12 days but may range up to 21 days. The first sign of infection is high fever. During this initial stage, patient may develop coryza, cough, red and watery eyes (conjunctivitis) and white spots inside the cheek known as Koplik s spot. After several days (2 4 days), a rash develops, usually started on the face and upper neck. The rash proceeds downwards, reaching hands and feet and lasted for five to sic days, then fades. The rash occurs, on average, at day 14 after exposure to the virus with a range of seven to 18 days, rarely as long as days. An infected individual can transmit the virus from four days prior to the onset of rash to four days after onset. The virus remains active and contagious in the air or on infected surfaces for up to two hours. 4

5 Figure 1: Koplik s spot and skin rash in person with measles infection Koplik s spot Maculopapular rash Rash begins around hairline, on face and neck, behind ears Rash spreads downward to chest and abdomen Downward trend spread of rash Rash effects arms and legs last

6 Figure 2: Time course of clinical events in measles disease Day of illness TEMPERATURE Measles Rash Koplik s Conjunctivitis Coryza Cough Source: Infectious Diseases of Children, 9th Edition, Figure 13-1, page 224, Editors Saul Krugman Samuel L. Katz, Anne A. Gershon, Catherine M. Wilfert. By permission of Mosby Year Book, St. Louis Missouri 1.3 COMPLICATION Measles is often a mild or moderate severe illness. However, severe measles likely occur in poorly nourished young children. The most serious complications include, blindness, encephalitis (1 per 1,000 cases), severe diarrhoea, ear infection (1 in every 5 10 cases) and pneumonia (5 10 % of cases). Case fatality rate in developing countries is in the range of 1% to 5%. 1.4 PEOPLE AT RISK Un-immunised persons, especially young children are at highest risk. People who have not been immunised with vaccine or who have not acquired immunity through having experienced the disease can become infected.

7 1.5 MEASLES VACCINE Measles vaccine was available since Measles vaccine induces long-term and probably lifelong immunity in most individuals. Natural infection produces lifelong immunity. Live attenuated measles virus vaccine are in use. Measles antibodies develop in approximately 85% of children vaccinated at 9 months of age, 95% of children vaccinated at 12 months of age and 98% of those vaccinated at 15 months of age. Second dose vaccination is given to children to overcome this lack detectable antibody. Measles vaccines available in form of monovalent, bivalent (MR measles-rubella) and trivalent (MMR measles-mumps-rubella). 1.6 MEASLES EPIDEMIOLOGY GLOBAL Worldwide, measles cases and deaths are under-reported especially in areas with the highest burden. In 2003, 528,400 cases were reported (from 174 countries) compared to 3,852,242 cases in 1980 (from 148 countries). Worldwide annual deaths from measles (2002) were estimated by WHO at 610,000. About 88.5% of them (540,000) occurred among children under 5 years of age. In Western Pacific Region, measles cases and deaths estimated of about one million and 30,000 per year, respectively. WHO and UNICEF estimated that the measles vaccination coverage in 2003 was around 77%.

8 PART MEASLES EPIDEMIOLOGY MALAYSIA In the pre vaccine era, measles was highly endemic among Malaysian population especially among children. Measles vaccination program was included as part of the Expanded Programme on Immunisation in 1982 and single dose measles vaccination was given to children at 9 months of age. Since the introduction of measles vaccination in Malaysia, the occurrence of measles reduced with the increased of the measles vaccination coverage. The incidence rate of measles reported cases in 1982 was per 100,000 populations. In , measles incidence rates in Malaysia were ranged between per 100,000 population. However, measles cases increased drastically in 1999 and 2000 with incidence rates (2,608 cases) and (6,187 cases) per 100,000 populations, respectively despite measles administrative immunization coverage was 86.6% (1999) and 88% (2000). In these two years, the increased of measles cases occurred in all states and outbreaks were scattered throughout the country both in urban and rural areas. The measles outbreak in suggested that the outbreak was due to primary vaccine failure and failure to vaccinate that caused accumulation of susceptible individuals 8

9 Figure 3: Measles incidence rate of measles reported cases and vaccination coverage, Malaysia, Incidence rate Immunisation Coverage 2.2 MEASLES ELIMINATION As we have succeeded in controlling measles occurrence at low level, the Ministry of Health in February 2003 decided to initiate measles elimination in Malaysia starting in Following this decision, vaccination and surveillance strategies have been reviewed and changed to achieve the elimination goals and objectives Goals and objectives The main goal of this elimination initiative is to achieve sustainable reduction of measles morbidity and mortality and to interrupt the transmission of indigenous measles virus in Malaysia. Specific objectives of elimination initiative are to; 1) maintain the number of susceptible individuals below the critical number required to sustain transmission of the virus; 2) eliminate measles by year 2010; 3) achieve 0 measles mortality. 9

10 2.2.2 Strategies Sustainable reduction of measles morbidity, mortality and interruption of the transmission of the indigenous measles virus in Malaysia are possible by implementing the following strategies; 1) Vaccination strategies routine two dose MMR vaccine given to children 2) Surveillance strategies enhancing measles surveillance with integration of epidemiological and laboratory information. 3) Laboratory strategies laboratory confirmation should be done on all suspect measles cases 4) Response to outbreak all measles outbreaks will be carefully investigated 5) Case management improving the management of every measles case 6) Training 2.3 MEASLES VACCINATION Schedule Two dose of measles vaccine are recommended as the 5 10 percent who fail to be protected by the first dose will nearly all be protected by the second. The measles vaccination schedule is as follows; Area Measles vaccination Age vaccination given Peninsular Malaysia First dose MMR 12 months and Sarawak Second dose MMR 7 year (standard one) Sabah First single dose 6 months measles First dose MMR Second dose MMR 12 months (1 year) 7 year (standard one) 10

11 2.3.2 Contraindications Contraindications include; individuals with proven anaphylaxis to neomycin children with immune suppression children who have received another live vaccine in previous month children with HIV infection who are severely immune compromised pregnant women women of children age, who should be advised to avoid pregnancy for the next three months after MMR of measles vaccine. 2.4 MEASLES SURVEILLANCE Adequate disease surveillance data and analysis will permit implementation of appropriate measures to control and eliminate measles. It also will be used in the assessment of progress and in making adjustments to programmes as required. Measles is a notifiablle disease under the Control of Communicable Disease Act In the elimination phase the surveillance of measles should be case-based or known as enhanced measles surveillance (laboratory confirmation should be done) Objectives The general objectives of measles surveillance are to immediate detecting any suspected cases, confirming cases by laboratory diagnosis and identifying importations and possible sources of infection so that can be used to plan, monitor and evaluate measles elimination programme. The specific objectives of measles surveillance are to; 1) monitor incidence and coverage in order to assess progress; 2) identify areas at high risk or with poor programme performance; 3) identifying high-risk population; 4) describe the changing epidemiology of measles in terms of age, immunization status and the intervals between epidemics; 11

12 5) predict the next outbreak that may occur because of a build-up of susceptible persons; 6) detect and investigate measles outbreaks so that cause of outbreaks can be determined 7) determine where measles virus is circulating; 8) assess the performance of surveillance system; 9) ensure proper case management Case definition Clinical case definition for suspect measles case that should be reported/ notify is as follows; Any person with fever and maculopapular rash and cough, coryza (runny nose) or conjunctivitis (red eyes) or Any person in whom a clinician suspects measles infection Case classification Case classification according to laboratory confirmation; Clinically confirmed: A case that meets the clinical case definition Laboratory confirmed: A case that meets the clinical case definition and is laboratory confirmed (based on laboratory criteria for diagnosis) Epidemiologically confirmed: A case that meets the clinical case definition and is linked epidemiologally to a laboratory confirmed case. 12

13 Case classification according to source of infection Indigenous infection: A person becomes infected in Malaysia (no history of out from Malaysia 21 days of rash onset), either, Epidemiologically linked to an international imported; or Not linked epidemiologically to an international imported case Imported infection: A person who has confirmed measles and whose rash onset was within 21 days of arrival in Malaysia Procedures of surveillance Flow of measles surveillance activities is as Appendix 1. i) Case detection take a proper history on the complaint of suspect measles cases who fulfil measles case definition if the onset of rash is less than 4 days, take blood/serum sample and urine or respiratory specimens from the patient if the onset of rash more than 4 days, take blood/serum from the patient send the clinical sample/s to laboratory identified by District Health Office together with Measles Laboratory Request From (MSLF: 01/2004 as Appendix 2). Procedures to collect, store and transport of samples are as in Appendix 3 and 4. The sample/s then transported to National Public Health Laboratory (NPHL), Sungai Buloh for confirmation. ii) Notification All suspect measles cases must be notified to nearest District Health Office within 48 hours of rash onset via telephone. As most of the cases detected within few days of rash onset, it is advisable that the case should be notified as soon as a case detected. Notification using Notification Form should follow using current system of notification. Notification Form and notification flow are as Appendix 5 and 6. 13

14 iii) Case investigation Identified Officer in District Health Office must investigate all suspect measles cases within 48 hours of notification using Measles Investigation Form. Investigation Form is as Appendix 7. iv) Case classification After case has been investigated and laboratory result has been available, case must be classified according the laboratory confirmation and source of infection as following (Appendix 8); clinically confirmed epidemiologically confirmed laboratory confirmed indigenous infection imported infection v) Data analysis and interpretation Data should be analyse on weekly basis and information should be generate Performance indicators The following are the performance indicators that should be evaluated on weekly basis. % of suspected cases notified within 48 hours of onset of rash % of suspected cases investigated % of cases investigated within 48 hours of notification % of cases with laboratory confirmation % of cases with adequate specimen taken % laboratory result (serology) within 7 days % laboratory result (virus isolation) within 14 days % of confirmed cases with sources of infection identified The target of all above indicators to be 80%. Laboratory confirmation Source of infection ** Details on procedures of measles surveillance, refer Measles Surveillance Manual 14

15 APPENDICES 15

16 Appendix 1 Flow chart of measles surveillance activities Case detection Case notification Health facility Case investigation Data verification & validation Case classification District Health Office Data analysis Interpretation Reports Information dissemination (feedback) State Health Department & Disease Control Division, Ministry of Health Action Evaluation 16

17 Appendix 2 No. Rujukan Makmal MSLF:01/2004 MEASLES - BORANG PERMOHONAN DAN KEPUTUSAN UJIAN MAKMAL A. MAKLUMAT PESAKIT Negeri: Daerah: Hospital / Klinik Kesihatan: Nama Pesakit: No. K/P: Umur: Jantina: L / P B. MAKLUMAT IMUNISASI MEASLES Imunisasi measles: Ada Tiada Tidak diketahui Tarikh dos terakhir diberi: C. MAKLUMAT KLINIKAL Gejala (Simptom) Ada / Tiada (Tandakan diruang berkenaan) Tarikh mula Demam Ruam (maculopapular rash) Konjunktivitis Batuk Coryza D. SPESIMEN KLINIKAL Spesimen: Pertama Kedua Spesimen (tandakan diruang berkenaan) Tarikh diambil Tarikh penghantaran Darah / Serum Sekresi pernafasan (Respiratory secretion) Air kencing (urine) E. MAKLUMAT PEMOHON Nama dan Cop Pegawai: No. telefon: No. Fax: Tandatangan: Keadaan spesimen: F. MAKMAL (Untuk Kegunaan Makmal) Tarikh terima spesimen: Spesimen Jenis ujian Keputusan ujian Komen Darah / Serum Sekresi pernafasan (Respiratory secretion) Air kencing (Urine) Nama dan tandatangan Pegawai Makmal: Jawatan Pegawai Makmal dan Cop Makmal: Tarikh: * Nota: Spesimen klinikal (darah / sekresi pernafasan / air kencing) hendaklah diambil jika pesakit disyakki sebagai kes measles. Defini kes (case definition) adalah seperti dinyatakan di belakang. Jika spesimen ini adalah spesimen kedua, maklumat klinikal dan imunisasi tidak perlu diisi jika telah diisi pada borang spesimen pertama. 17

18 (at the back of laboratory request form) Measles Definisi Kes Seseorang yang mengalami gejala berikut; Demam dan ruam (maculopapular rash) dan; konjunktivitis atau batuk atau coryza atau Sesiapa yang didiagnos sebagai kes campak oleh Pegawai Perubatan Case Definition Any person with Fever and maculopapular rash and; conjunctivitis or cough or coryza or Any person in whom a clinician suspects measles infection 18

19 PROCEDURES TO COLLECT, STORE AND TRANSPORT CLINICAL SPECIMENS Basic kit for specimen collection Equipments: 1. Needles 2. Syringes 3. Tourniquet 4. Sharp bins 5. Gloves, alcohol swabs 6. Sterile urine container 7. Plain Screw-capped tube (do not use vacutainer) 8. VTM ( Viral transport medium) 9. Sterile cotton swab 10. Cold box 11. Ice packs 12. Ziplock (biohazard) plastic bag 13. Specimen Measles Surveillance Laboratory Form (MSLF-001) 14. Specimen label Appendix 3 19

20 Blood Specimen collection for measles specific IgM test Appendix 3a Take 5ml of venous blood for adult, 2.5ml for children (< 7 y.o ) Use plain tube with screw cap (do not use vacutainer). Blood to be taken any time, preferable 4 to 28 days after the onset of rashes Label the container with patient identification and collection date (name, Full new I/C No., date of specimen taken, type of test eg. Measles Specific IgM) Complete the request form including the last measles immunization date, onset of rash, date specimen taken, telephone and fax numbers and name of requesting medical officer. Centrifuge the specimen at 1000 X g for 10 minutes to separate the serum from the blood cells (immediately after the specimen taken) Transfer the serum into a new plain tube Label the new container with patient identification and collection date (name, Full new I/C no., date of specimen taken, type of test eg. Measles Specific IgM) Put the specimens into their respective biohazard bag and individually packed Store the specimen at 4 8 o C before and during transportation (use cold box with ice pack) Send to National Public Health Laboratory (NPHL) Sungai Buloh Note: Maximum period of specimen storage is seven days before transportation 20

21 Appendix 3b Urine specimen collection for measles virus isolation Collect ml of urine into a sterile screw-capped container. First passed, morning specimens of urine are preferable. Urine can be collected as soon after rash onset and at least within 5 days of rash onset Label the container with patient identification and collection date (name, Full New I/C No., date of specimen taken, type of test eg. Measles Virus Isolation) Complete the request form including the last measles immunization date given, onset of rash, date specimen taken, telephone and fax numbers and name of requesting medical officer. Put the specimens into their respective biohazard bag and should be individually packed Store the specimen at 4 8 o C before and during transportation (use cold box with ice pack) and send to National Public Health Laboratory (NPHL) within 24 hours. 21

22 Appendix 3c Nasopharyngeal specimen collection for measles virus isolation Collect nasopharyngeal specimen (aspirates or lavage) and put into a sterile screw-capped container. The specimen should be collected as soon as possible after onset and not longer than 7 days after the appearance of rash Label the container with patient identification and collection date (Name, Full New I/C No., date of specimen taken, type of test eg. Measles Virus Isolation) Complete the request form including the last measles immunization date, onset of rash, date specimen taken, telephone and fax numbers and name of requesting medical officer. Put the specimen into their respective biohazard bag. Specimen should be individually packed. Store the specimen at 4 8 o C before and during transportation (use cold box with ice pack) and send to National Public Health Laboratory (NPHL) within 24 hours. 22

23 Appendix 3d Throat / nasal swab specimen collection for measles virus isolation Take throat / nasal swab and put into 2.0 ml Viral Transport Medium (VTM) [VTM can be purchased / supplied by PHL] Label the container with patient identification and collection date (name, Full New I/C No., date of specimen taken, type of test eg. Measles Virus Isolation) Complete the request form including the last measles immunization date, onset of rash, date specimen taken, telephone and fax numbers and name of requesting medical officer. Put the specimen into their respective biohazard bag. Specimen should be individually packed. Store the specimen at 4 8 o C before and during transportation (use cold box with ice pack) and send to National Public Health Laboratory (NPHL) within 24 hours. 23

24 Appendix 4 Flow chart of clinical specimens for laboratory confirmation and result Health facility (Blood / Respiratory secretion / Urine) Specimen Local laboratory at District Level (identified by District Health Office) Local laboratory can send sample direct to NPHL State laboratory Specimen Specimen Result National Public Health (NPHL) Sungai Buloh Result District Health Office Result Result Disease Control Division 24

25 A. MAKLUMAT PESAKIT. 1. Nama Penuh(HURUF BESAR) : Appendix 5 Borang: Health 1 Rev 2001 BORANG No Siri:. Subperaturan 10(2) AKTA PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT 1988 PERATURAN-PERATURAN PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT (BORANG NOTIS) 1993 NOTIFIKASI PENYAKIT BERJANGKIT YANG PERLU DILAPORKAN Nama Ibu/Bapa/Penjaga (Jika 12 Tahun Dan Ke bawah) : 2. No. Pengenalan Diri/Dokumen Perjalanan : Sendiri Pengiring 3. Warganegara Malaysia: No. Daftar Hospital/Klinik: Ya Keturunan : Subketurunan : Tahun : Tidak Negara Asal : Izin Tanpa Izin Pemastautin Tetap No./Nama Wad: 4. Jantina : Lelaki Perempuan 5. Tarikh Lahir : Umur : Hari/ Bulan/ Tahun 7. Pekerjaan : (Jika tidak bekerja, nyatakan status diri) : 8. Alamat Kediaman: Poskod Negeri 9. Alamat Tempat Kerja/Belajar/Pusat Asuhan Kanak-Kanak:( Nyatakan alamat tempat kejadian jika Keracunan Makanan) Poskod Negeri 10. Nombor Telefon : Ada Tiada Rumah : Pejabat : Tel. Bimbit : B. DIAGNOSIS PENYAKIT 11. Pilihan Diagnosis 1. Acute Flaccid Paralysis 16. Kolera. 31. Tuberkulosis PTB smear positif. 2. AIDS. 17. Kusta (Paucibacillary). 32. Tuberkulosis PTB smear negatif. 3. Batuk Kokol. 18. Kusta (Multibacillary). 33. Tuberkulosis Extra Pulmonary. 4. Campak. 19. Malaria (Sp: ). 34. Tuberkulosis Extra PTB dengan smear +ve. 5. Chancroid. 20. Plague (Jenis:.. ). 35. Tuberkulosis Extra PTB dengan smear ve. 6. Demam Denggi 21. Poliomielitis (Akut). 36. Viral Ensefalitis Japanese. 7. Demam Denggi Berdarah. 22. Rabies. 37. Viral Ensefalitis Nipah 8. Demam Kuning 23. Relapsing Fever. 38. Viral Ensefalitis (Lain-lain). 9. Difteria. 24. Sifilis acquired. 39. Viral Hepatitis A (Akut). 10. Disenteri. 25. Sifilis congenital. 40. Viral Hepatitis B (Akut). 11. Ebola. 26. Tetanus Neonatorum. 41. Viral Hepatitis C (Akut). 12. Gonorea. 27. Tetanus (Lain-lain). 42. Viral Hepatitis Lain-lain (Akut). 13. Hand, Foot and Mouth Disease. 28. Tifoid Salmonella typhi. 43. Lain-lain (Nyatakan): HIV 29. Tifoid Paratyphoid (Jenis:. ). 15. Keracunan Makanan. 30. Tifus scrub. 12. Status Pesakit : Tarikh Mati : 13. Tarikh Mula : Hidup Mati 14. Cara Pengesanan : Kes Kontek Kes FOMEMA Ujian Saringan (.) Notifikasi melalui telefon dalam masa 24 jam perlu dilakukan bagi kes berikut selain dari notifikasi bertulis : Poliomielitis (Akut), Kolera, Demam Denggi, Difteria, Keracunan Makanan, Plague, Rabies dan Demam Kuning 15. Status Diagnosis (Mengikut Definisi Kes) 16. Ujian Makmal/Siasatan : Ada Tiada Sementara (Provisional/Suspected) 17. Nama Ujian Makmal/Siasatan : Disahkan (Confirmed) 18. Tarikh Sampel Diambil/ 19. Keputusan Ujian Makmal/Siasatan : Siasatan Dibuat : Positif Negatif Belum Siap Tarikh Diagnosis : Maklumat Klinikal Yang Relevan: 21. Komen : 22. Nama Pengamal Perubatan(HURUF BESAR) : C. MAKLUMAT PEMBERITAHU 23. Nama Hospital/Klinik dan Alamat : 24. Tarikh Notifikasi : 25. No Telefon : 26. No Faks:

26 Appendix 6 NOTIFICATION FLOW Health facility / Community Via telephone / other communication system Feedback District Health Office Case-based investigation Via CDCIS Disease Control Division & IDS Analysis Interpretation Response Feedback State Health Department Analysis Interpretation Response 26

27 Appendix 7 BORANG SIASATAN CAMPAK (MEASLES) KEMENTERIAN KESIHATAN MALALAYSIA Nota : Semua kes yang disyaki sebagai kes campak yang dilaporkan hendaklah disiasat dengan serta merta dan tidak lewat dari tempoh 48 jam selepas notifikasi. FASILITI Negeri : Daerah Kesihatan: Pejabat Kesihatan Daerah : MAKLUMAT PESAKIT Nama Pesakit : Diagnosa : MAKLUMAT NOTIFIKASI Tarikh Diagnosa : Tarikh Notifikasi : / / No. K/P : Jantina : T. Lahir : Umur : Punca Pengesahan Kes : Aktif Warganegara : Nama Pemberitahu : Pasif Ya; Kumpulan Etnik : Nama Fasiliti Pemberitahu : Tidak; Negara Asal : No. Telefon / Faks : Status Imigrasi : No. Rujukan Kes : Alamat Kediaman : / / MAKLUMAT SIASATAN KES Tarikh Notifikasi Diterima : / / Alamat Tempat Kerja : Tarikh Kes Didaftar : / / No. daftar kes: No. Telefon :- Rumah: Pejabat: Tarikh Siasatan : / / Tel. Bimbit: Nama Penyiasat Kes : E-Mel : Jawatan : Pekerjaan : MAKLUMAT KLINIKAL Demam : Ruam : Jenis Ruam : Ya; Tarikh mula : / / Ya; Tarikh mula : / / Maculopapular Tidak Tidak Maculo-vesicular Tidak Diketahui Tidak Diketahui Batuk : Coryza : Conjunctivitis : Ya Ya Ya Tidak Tidak Tidak Tidak Diketahui Tidak Diketahui Tidak Diketahui Jika tiada sebarang simptom campak, adakah diagnosa campak ini dibuat oleh Pegawai Perubatan/Pengamal Perubatan? Ya Tidak Status rawatan : Pesakit Luar Jika ya, catitkan, Pesakit Dalam Nama Pegawai /Pengamal Perubatan : Jawatan: 27

28 (Samb.) MAKLUMAT KLINIKAL Adakah kes mengalami komplikasi jangkitan : Tiada Tidak Diketahui Diarrhea Otitis media Encephalitis / SSPE Lain-lain, nyatakan : Status kes : Hidup Mati; Tarikh Mati : / / Tidak Diketahui EPIDEMIOLOGI KES (PUNCA JANGKITAN) Adakah kes mempunyai kontak dengan pesakit campak yang lain dalam tempoh 7 12 hari sebelum mula ruam? Ya Tiada Tidak Diketahui Jika ada, catitkan ; Nama : No. Daftar : Tarikh mula ruam : / / Adakah terdapat kes campak yang dilaporkan di lokaliti tersebut sebelum kes ini (dalam tempoh inkubasi yang sama)? Ya Tiada Tidak Diketahui Jika ada, catitkan ; Nama : No. Daftar : Tarikh mula ruam : / / Adakah kes keluar negara dalam tempoh 7 21 hari sebelum tarikh mula ruam? Ya Tiada Tidak Diketahui Adakah kes bekerja di dalam bidang pelancongan atau bekerja di kawasan/tempat yang terdapat ramai pelancong antarabangsa/pendatang? Ya Tiada Tidak Diketahui Individu disyaki kes campak yang dikesan semasa penyiasatan kes : Nama : No. K.Pengenalan : Adakah terjadi wabak? Ya Tidak Jika ya, nombor wabak : / (nombor / tahun) MAKLUMAT UJIAN MAKMAL Sampel darah/serum untuk ujian serologi Sampel darah/serum diambil : Ya Tiada Tidak Diketahui Tarikh Keputusan Ujian IgM Jenis Sampel Pengambilan Sampel Terima Keputusan Sampel Hantar ke Sampel oleh Ujian MKAK MKAK dilaporkan Positif Negatif Equivocal Tidak Diketahui Sampel Darah Pertama Sampel Darah Kedua 28

29 (Samb.) MAKLUMAT UJIAN MAKMAL Sampel sekresi respiratori/urin untuk ujian viral culture & indentification : Sampel sekresi respiratori/urin diambil : Ya Tiada Tidak Diketahui Tarikh Keputusan Ujian viral culture & indentification Jenis Sampel Pengambilan Sampel Terima Keputusan Sampel Hantar ke Sampel oleh Ujian MKAK MKAK dilaporkan Positif & Nama Virus Negatif Tidak Diketahui Sekresi respiratori Urin STATUS IMUNISASI CAMPAK Telah diberi imunisasi campak Ya Tiada Belum layak Tidak Diketahui Sumber maklumat imunisasi : Kad imunisasi Sejarah lisan Tidak diketahui Bilangan Dos : Tarikh dos terakhir diberi : KLASIFIKASI KES Kes yang dilaporkan ini dikategori sebagai : Status jangkitan/penularan kes ini : Clinically confirmed Epidemiologically-linked Laboratory confirmed Jangkitan tempatan Imported Cases Tidak dapat ditentukan Discarded ULASAN Nama Pegawai Kesihatan Daerah: Tarikh : 29

30 Appendix 8 CLASSIFICATION OF MEASLES CASE IgM positive Laboratory confirmed Specimen adequate IgM negative Discard Suspect case (Clinical case) If the serum specimens taken < 4 days of onset of rash & result negative for Measles IgM and no 2 nd serum specimen or no urine / respiratory specimens taken If the cases not fulfilled case definition Epidemiological linked to laboratory confirmed case Epidemiologically confirmed No specimen / no adequate specimen No epidemiological linked to laboratory confirmed case Clinically confirmed Note: Case should be classified as clinically confirmed even though serology test result negative with adequate specimen if the specimen taken < 4 days of rash onset and no second serum specimen or urine / respiratory specimens taken. Suspect case also can be classified as discard if the case is obviously not fulfilled case definition 30

31 Telephone Numbers Any questions regarding the Prevention and Control of Measles in Malaysia, please contact the Medical Officer of Health (Epidemiology) at the Communicable Disease Control Section, Disease Control Division, Ministry of Health or/and the State Health Department as follows, No. State Health Department Tel. No. Fax No. 1. Communicable Disease Control Section Disease Control Division Ministry of Health Perlis State Health Department Kedah State Health Department P. Pinang State Health Department Perak State Health Department Selangor State Health Department K.L.F.T. Health Department N. Sembilan State Health Department Melaka State Health Department Johor State Health Department Pahang State Health Department Terengganu State Health Department Kelantan State Health Department Sabah State Health Department Sarawak State Health Department Labuan F.T. Health Department

32 REFERENCES 1. Module on best practice for measles surveillance. Geneva, World Health Organization, WHO Guidelines for Epidemic Preparedness and Response to Measles Outbreaks. Geneva, World Health Organization, Expanded Programme on Immunization Using Surveillance Data and Outbreak Investigations to Strengthen Measles Immunization Programmes. Geneva, World Health Organization, Manual for the laboratory diagnosis of measles viral infection. Geneva, World Health Organization, Plan of action Revised national immunisation programme for children with a special focus on Hib and MMR immunisation. Ministry of Health, Malaysia, Rosemawati A. Measles situation in Malaysia Ministry of Health, Malaysia, 2003 (unpublished document) 32

33 ACKNOWLEDGEMENT We would like to thanks the following persons for made this handbook possible; Y. Bhg. Dato Dr. Hj. Ramlee Hj. Rahmat Director of Disease Control Dr. Abdul Rasid Kasri Deputy Director of Disease Control (Com. Disease) Dr. Hasan Abdul Rahman Director Pahang State Health Department [formerly the Deputy Director of Disease Control (Com. Disease)] Dr. Devan Kurup Principal Assistant Director Communicable Disease Control Section All Participants of the Operationalisation of Enhanced Measles Surveillance & Mass Campaign Meeting, 9 12 December 2003, Le Paris Hotel, Port Dickson Prepared by Dr. Rosemawati Ariffin Principal Assistant Director Communicable Disease Control Section 33

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